EP564 - The optimal treatment for pouch disorders with ulcerative colitis based on the analysis of clinical course after treatments

Sunday, May 10, 2026

2:52 PM - 2:57 PM ET

ePoster Presenter(s)

Akira Sugita, MD. PhD (he/him/his)

Clinical adviser
Dep. of IBD, Yokohama Municipal Citizen's Hospital
The Research Group of Intractable Inflammatory Bowel Disease, Japanese Ministry of Health, Welfare and Labor
Yokohama, Kanagawa, Japan

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Author(s)

HK

Hirosuke Kuroki, n/a

Manager
Dep. of IBD, Yokohama Municipal Citizen's Hospital
Yokohama, Kanagawa, Japan

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KG

Kouki Gotoh, MD. PhD

Stuff
Dep. of IBD, Yokohama Municipal Citizen's Hospital
yokohama, Kanagawa, Japan

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NO

Nao Obara, MD. PhD

Stuff
Dep. of IBD, Yokohama Municipal Citizen's Hospital
yokohama, Kanagawa, Japan

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EN

Eiichi Nakao, MD. PhD

Stuff
Dep. of IBD, Yokohama Municipal Citizen's Hospital
yokohama, Kanagawa, Japan

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KK

Kazutaka Koganei, MD. PhD

Director
Dep. of IBD, Yokohama Municipal Citizen's Hospital
yokohama, Kanagawa, Japan

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HK

Hideaki Kimura, MD, PhD

Director
Yokohama city University Medical Center
Yokohama, Kanagawa, Japan

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Senior Author(s)

kT

kenji Tatsumi, MD. PhD

Manager
Dep. of IBD, Yokohama Municipal Citizen's Hospital
Yokohama, Kanagawa, Japan

Disclosure information not submitted.

Purpose/Background: Pouch disorders interrupt patients’ QOL after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) in ulcerative colitis (UC). However, the optimal treatments for pouch disorders have not been established yet.
This study was conducted to examine the optimal treatments for each pouch disorder based on the clinical course after treatments.

Methods/Interventions: Thirteen hundred and ninety-four UC pouch patients (hand sewn IPAA 213, stapled IPAA with preservation of cuff and ATZ 1181) in our institution were included. Pouch disorders included prepouch ileitis, chronic pouchitis (CADP, CARP), cuffitis, Crohn’s like disease of the pouch, and pouch neoplasia. The clinical course after treatment for each disorder were analyzed retrospectively.

Results/Outcomes: 1) Prepouch ileitis was detected in 2%(28 cases) and one with stricture underwent ileal resection. 2) Chronic pouchitis was diagnosed in 3.7% (52 cases). Eleven cases were treated with vedolizumab (effective in 82% patients with normalization of modified PDAI after 17.2months), 2 with ileostomy, and 3 with pouch excision. 3) Cuffitis was detected in1% (14 cases). Four were treated effectively with anti TNFα antibody drug, one effectively with upadacitinib, 3 with diverting ileostomy and 3 with pouch excision including 3 cases with vaginal fistula.4) Crohn’s like disease of the pouch was diagnosed in 0.5% (7 cases). Four were effectively treated with anti TNFα antibody drug, and 2 with surgery. 5) Pouch neoplasia was detected in 0.9% (12cases: pouch body 5. cuff and ATZ 6, fistula tract from the anastomosis 1). All patients underwent pouch excision.

Conclusion/Discussion: Pouch disorders with UC are important to be detected early by a regular pouch endoscopy with attention to clinical symptoms and the optimal treatments with biologics or surgery should be suitably performed for each disorder. Vedolizumab is the alternative, effective treatment for chronic pouchits.